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General NPI Number Information
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NPI Number | 1144620386
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Entity Type | Individual
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Provider Name | JONATHAN BLANDO D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 26 KELLOGG RD
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City | NEW HARTFORD
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State | NY
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Zip | 13413-2825
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Country | US
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Telephone | 315-765-0478
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Fax | 315-765-0478
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Provider Business Mailing Address
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Address Line | 26 KELLOGG RD
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City | NEW HARTFORD
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State | NY
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Zip | 13413-2825
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Country | US
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Telephone | 315-765-0478
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Fax | 315-765-0478
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 012620
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License Number State | NY
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